Abstract
To evaluate the effectiveness of topical Bevacizumab in preventing neovascularisation on high risk corneal grafts. This study was a randomized, controlled, parallel group study, carried out from February 2008 to April 2012 (51 months) at Isra Postgraduate Institute of Ophthalmology and Yasin eye hospital, Karachi. Eyes with high risk corneal transplantation with corneal neovascularization were included in this interventional study/randomized clinical trial. Patients were randomly allocated to 2 groups. Group A and Group B. After penetrating keratoplasty, group A patients received topical bevacizumab (2.5%, 25 mg/ml) which was self-administered 4 times a day for 24 week while group B patients received only sham eye drops. Group B was the control group. Corneal neovascular invasion area i.e. the fraction of area on transplanted cornea in which vessels were present was measured using mathematical software program MatLab. Data analyses was done using SPSS version 19. Frequencies of age gender and groups were measured. Neovascular invasion area and change in visual acuity was compared between the 2 groups using paired t test . P value of less than 0.05 was considered significant. Among the 2 groups mean Corneal neo vascular invasion area was minimum in group A (6.23%) while in group B it was (26.7%). Maximum number of patients (26) attained visual acuity of 6/36 or better in the topical bevacizumab group compared to 17 sham group. When topical Bevacizumab is used, it reduces the recurrence of neovascularisation and thus helps increasing the frequency of graft survival in cases of high risk corneal transplants.
Highlights
Corneal graft failure is one of the most common causes of performing keratoplasty again.[1]
Eighty one Patients were included in the study, of them were in the group A, in Group B Out of these 81 patients, 62 (76.5%) were males while 19 (23.5%) were females
Among the 2 groups mean corneal neovascular invasion area was minimum in the topical bevacizumabgroup, with p value = 0.03 (Table-I)
Summary
Corneal graft failure is one of the most common causes of performing keratoplasty again.[1] When vessels are present on the cornea chances of graft rejection are very high, and it is considered as a high risk corneal graft surgery.[2] This high rate of corneal graft failure in cases of vascularized corneas is because after corneal graft these patient can still develop severe immune reaction against the graft and even immunosuppressive therapy cannot help much in the graft survival in such cases.[3]. Many investigations have been carried out to modulate this immune reaction in order to improve keratoplasty results, including prevention of further angiogenesis.[4,5] Many molecular factors. Many VEGF inhibitors have been identified and are used for many retinal disorders,[7] one of such VEGEF inhibitor is Bevacizumab
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